Collateral Information

Section

Loan #

Past Due Date

Past Due Amount

Monthly Payment

Loan Balance

Assignment Type

Additional Information

Note: Should you have any information regarding family members, relatives of the debtor, or any unique or defining information that would be helpful in aiding us in the recovery of your vehicle, please enter that information in the "Instructions" space below.

Additional Information

Authorization

This is your authorization to process for collection, location, or repossession of the above described assignment. We agree to indemnify and save you harmless from and against any claims, damage, losses, and action resulting from or arising out of your efforts to collect, locate or repossess the above claim, except, however such as may because or arises out of negligence or unauthorized acts of your company, it’s officers, employees, or the officers or employees of such agents.